Car a e e o f o th f e th e Pati Pa e ti n e t n wi w th i th a Mus u c s u c l u o l s o k s e k l e e l t e al a l Dis i o s r o de d r

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1 Care of the Patient with a Musculoskeletal Disorder 1 Slide 1 Overview of Anatomy and Physiology Function of the bones Support Protection Movement Mineral storage Hemopoiesis Slide 2 Functions of the muscles Motion Maintenance of posture Production of heat Slide 3 1

Rheumatoid arthritis Etiology/pathophysiology Autoimmune disorder, but may also be genetic Chronic inflammation of the joints Slide 4 Rheumatoid arthritis Clinical manifestations Characterized by

2 Rheumatoid arthritis Etiology/pathophysiology Autoimmune disorder, but may also be genetic Chronic inflammation of the joints Slide 4 Rheumatoid arthritis Clinical manifestations Characterized by periods of remission and exacerbation Generalized aching Edema and tenderness of joints Limited range of motion (morning stiffness) Slide 5 (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2 nd ed.]. St. Louis: Mosby.) Rheumatoid arthritis of hands. Slide 6 2

3 Rheumatoid arthritis Laboratory tests Erythrocyte sedimentation rate (ESR) Rheumatoid factor (RF) Slide 7 Rheumatoid arthritis Treatment Medications: potent antiinflammatory agents slow-acting antiinflammatory agents exercise: range of motion 2-3 times per day Heat: Hot packs, heat lamp, and/or hot paraffin Rehabilitation Slide 8 Osteoarthritis Degenerative joint disease Non-inflammatory Bones and joints wear out Caused by trauma, infections, previous fractures, rheumatoid arthritis, stress on weightbearing joints Slide 9 3

4 Osteoarthritis Medical management/nursing interventions Heat applications Gait enhancers (canes, walkers, etc.) Medications Salicylates (aspirin), NSAIDs (Motrin), steroids (cortisone) Surgery Joint replacement Slide 10 Gout Etiology/pathophysiology accumulation of uric acid in the blood ineffective metabolism of purines Primary: hereditary factors Affects men more frequently than women Slide 11 Slide 12 4

5 Less consumption of meat products that have high purine content, such as beef, pork and lamb, as do organs like liver, kidney, and brain, along with gravy enriched with meat extracts. Avoid alcohol Slide 13 Gout Clinical manifestations/assessment Excruciating pain Edema Inflammation (most common in the great toe) Diagnostic tests Serum and uric acid level Slide 14 Gout Gout Medical management/nursing interventions Medications Colchicine, indomethacin (Indocin), corticosteroids, allopurinol (Zyloprim) Slide 15 5

6 Osteoporosis Etiology/pathophysiology Reduction of bone mass Porous and brittle bones Slide 16 Slide 17 All women are generally at risk for developing osteoporosis due to hormonal changes that occur at menopause. (Hormones control when bone tissue is broken down to access stored calcium Slide 18 6

7 Osteoporosis Diagnostic tests Radiography studies Medical management/nursing interventions Calcium supplements, vitamin D Weight-bearing exercises Estrogen, Fosamax Diet: milk and dairy products Slide 19 Fibromyalgia syndrome (FMS) Etiology/pathophysiology Chronic Musculoskeletal pain syndrome Unknown etiology Clinical manifestations/assessment Widespread pain & tenderness Muscle tension in the shoulders, low back, hips Tension headache Slide 20 Fibromyalgia syndrome Diagnostic tests No specific laboratory or radiographic tests diagnose FMS Medical management/nursing interventions Patient education and reassurance Tricyclic antidepressants Exercise Relaxation techniques Slide 21 7

Surgical Interventions for Total Knee or Total Hip Replacement Knee arthroplasty (total knee replacement)

arthroplasty (total hip replacement) Replacement of the hip joint Slide 22 Figure 44-11 (From Phipps, W.J.

Medical-surgical nursing: health and illness perspectives. [7 th ed.]. St. Louis: Mosby.

8 Surgical Interventions for Total Knee or Total Hip Replacement Knee arthroplasty (total knee replacement) Replacement of the knee joint Restore motion of the joint, relieve pain, or correct deformity Hip arthroplasty (total hip replacement) Replacement of the hip joint Slide 22 Figure (From Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F., Neighbors, M. [2003]. Medical-surgical nursing: health and illness perspectives. [7 th ed.]. St. Louis: Mosby.) A, Tibial and femoral components of total knee prosthesis. B, Total knee prosthesis in place. Slide 23 Figure Hip arthroplasty (total hip replacement). Slide 24 8

$Fractures Fracture of the hip Most common type of fracture Clinical$ leg voluntarily Slide 25 Figure 44-16 Fractures of the hip.

Medical management/nursing interventions Buck s traction until surgery

9 Fractures Fracture of the hip Most common type of fracture Clinical manifestations/assessment Severe pain at site Inability to move the leg voluntarily Slide 25 Figure Fractures of the hip. Slide 26 Fracture of the hip Diagnostic test Radiographic examination Medical management/nursing interventions Buck s traction until surgery Surgical repair Internal fixation Neufeld nail and screws Prosthetic implants Slide 27 9

Fracture of the hip Postoperative interventions Maintain leg abduction Limit weight-bearing on affected side Chairs and commode seats should be raised to prevent flexion of hip beyond 60

10 Fracture of the hip Postoperative interventions Maintain leg abduction Limit weight-bearing on affected side Chairs and commode seats should be raised to prevent flexion of hip beyond 60 degrees Slide 28 Slide 29 Fracture of the vertebrae Etiology/pathophysiology Diving accidents Blows to the head or body Osteoporosis Metastatic cancer Motorcycle and car accidents Slide 30 10

11 Fracture of the vertebrae Clinical manifestations/assessment Pain at site of injury Partial or complete loss of mobility or sensation Evidence of fracture/fracture dislocation on x-ray Medical management/nursing interventions Stable injuries Pain medication, muscle relaxants Back support, brace, or cast Unstable fractures Traction, open reduction Slide 31 Fracture of the Pelvis Etiology/pathophysiology Falls, automobile accidents, crushing accidents Clinical manifestations/assessment Unable to bear weight without discomfort Medical management/nursing interventions Bedrest More severe fractures may require surgery and/or spica or body cast Slide 32 Traumatic Injuries Contusion: A blow or blunt force which causes local bleeding under the skin Sprains: Wrenching or hyperextension of a joint Strains: Microscopic muscle tears as a result of overstretching muscles and tendons Slide 33 11

Traumatic Injuries Contusions, sprains, whiplash, strains Medical management/nursing interventions Elevate injured area Cold compresses for 15-20 minutes intermittently for

median nerve between the carpal ligament and other structures Predisposing factors Occupations involving repetitious motions of the fingers and hands Slide 35 (From Thompson,

12 Traumatic Injuries Contusions, sprains, whiplash, strains Medical management/nursing interventions Elevate injured area Cold compresses for minutes intermittently for hours Warm compresses for minutes four times a day after 24 hours Slide 34 Traumatic Injuries Carpal tunnel syndrome Etiology/pathophysiology Compression of the median nerve between the carpal ligament and other structures Predisposing factors Occupations involving repetitious motions of the fingers and hands Slide 35 (From Thompson, J.M., et al. [2002]. Mosby s clinical nursing. [5 th ed.]. St. Louis: Mosby.) A, Wrist structures involved in carpal tunnel syndrome. B, Decompression of median nerve. Slide 36 12

grasp or hold small objects Edema of the

13 Traumatic Injuries Carpal tunnel syndrome Clinical manifestations/assessment Burning pain or tingling in the hands Inability to grasp or hold small objects Edema of the hand, wrist, or fingers Slide 37 Kyphosis A rounding of the thoracic spine Hump-backed appearance Slide 38 Scoliosis Lateral curvature of the spine Slide 39 13

14 Lordosis An increase in the curve at the lumbar region Slide 40 14

Chapter 43. Care of the Patient with a Musculoskeletal Disorder

Chapter 43. Care of the Patient with a Musculoskeletal Disorder Chapter 43 Care of the Patient with a Musculoskeletal Disorder All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Support Protection Movement